While Australians expressed outrage at revelations this week that patients are paying thousands of dollars in out-of-pocket expenses for surgeons’ fees, one GP wasn’t surprised.
Dr Richard Zhu has been on a one-man crusade to provide a transparent online marketplace for specialist services, including fees, to inform referring doctors and patients who deserve to know.
The ABC Four Corners investigation – Mind the Gap – broadcast on Monday provided a sobering look at medical costs that soared far above the Medicare schedule fees and private health insurance refunds at a time of serious illness for patients.
Mother of two Madonna Buiter told the ABC her out-of-pocket costs for breast cancer treatment were almost $16,000, and she and her husband were forced to use their house deposit to cover her gap costs.
"They say, 'Oh well, you should shop around and find a cheaper surgeon'," she told Four Corners.
"Well, that sounds great in theory, but on this side of my journey, I can say now when you're given that diagnosis, you have breast cancer, you need surgery. I don't know that that's realistic or reasonable at that time."
According to the ABC’s Dr Norman Swan, many blame Medicare and the private health funds, but often the cause lies in the healthcare providers.
Since 2016, Zhu has run Seekmedi.com, which is designed to reveal the consultation fees of medical specialists, surgeons and allied health professionals.
The doctor, who has faced legal threats and demands from specialists to remove their details, watched Four Corners with a sense of sadness but said even he was astonished by the extent of the problem.
“I am saddened by the fact some of my surgeon colleagues forgot that our health professionals’ primary goal is to treat and help people,” Zhu told Healthcare IT News Australia.
While he believes it is only a small proportion of surgeons doing the wrong thing, he said it’s an important issue that needs to be addressed urgently before more specialists and other health professionals become part of the story, and “ultimately bring disrepute to the whole profession”.
For reform to happen, Zhu said it’s crucial that patients and GPs have quick access to accurate information on specialists’ expertise and fees.
“I have always been frustrated to have patients coming back to me complaining about expensive specialists’ fees, which I don’t have a clue about. As a matter of fact, all GPs don’t have a clue. But these complaints seem to be occurring more and more. It alerts me to the fact that specialists’ fees might be becoming more and more expensive,” Zhu said.
Technology was an obvious solution and he created Seekmedi, which is one of a few sites publishing information on specialists, including mind-the-gap.com.au, healthshare.com.au and whitecoat.com.au, to provide some transparency.
But some specialists have been resistant to the scrutiny.
“I received a letter from a lawyer on behalf of an ophthalmologist demanding me to take his details off my website because he believes I did not obtain his consent. There have been similar letters sent to me from a few practice managers. However, I try to be firm in my vision,” Zhu said.
The Australian Healthcare and Hospitals Association’s Chief Executive Alison Verhoeven described the Four Corners report as “a warning bell that our political leaders should heed,” and said the problem is compounded when patients need to see several different health service providers for their conditions with many tests and treatments performed outside hospital where they may not be claimable on health insurance.
‘People’s first-hand accounts of the significant costs incurred in managing their health cannot be ignored, nor brushed over with statements about high bulk-billing rates, a few rogue specialists and planned insurance reforms which will do little, if anything, to address the problem,” she said.
‘As a starting point, the government could task the MBS Review Taskforce with investigating options for bundled payments for high-need patients, such as those requiring treatment for cancer. This would assist in addressing variation in doctors’ fees, as well as the unanticipated and sometimes unaffordable bills that land in the patient’s lap throughout their care journey.
‘With each provider charging for their services and no clear idea on the claimability or benefits payable on the various items, either from private health insurance or Medicare, the overall amount of money the patient is required to spend can add to something significantly more than first anticipated.”
Seekmedi has a section for patients to send in photos of specialists’ receipts. Meanwhile specialists are able to provide information on their expertise and fees, although he says: “it seems to be wishful thinking; I have only received 50 or so from specialists doing that.”
As a result, Zhu has updated the bios of most of the specialists across Australia, as well as consult fees, Medicare rebate, gap fee and pension rate, and for those who participate in the no-gap scheme he adds that in too.
“Because like any other fields, only by putting professionals on a comparison site will it create competition in a free market. It will always bring fees down or at least provide a downward pressure on fees,” he said.
Seekmedi is now moving into another area of frustration for GPs, specialists’ offices and patients, with users soon able to book specialists’ appointments via the platform.
“I believe [it] will cut down the time specialist's secretaries spend answering millions of phone calls, enable patients to view exactly how long the waiting time is for the specialists, and make bookings as easy as it is to reserve a restaurant online.”
Following this week’s elevated attention on the issue of out-of-pocket medical expenses, Zhu said he hopes doctors and patients will now look in greater numbers online to find solutions to a critical problem.
“Just like one of the patient in the story pointed out towards the end, it is troublesome to think there are people out there avoiding vital specialist treatments simply because of the fear of excessive fees. Thus, having a website like Seekmedi, it can potentially save time, save money, lead to earlier diagnosis and, I believe, save lives too.”